J Bone Joint Surg Am. 2026 May 13. doi: 10.2106/JBJS.25.01476. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to compare an anterior quadratus lumborum block (aQLB) plus a lateral femoral cutaneous nerve block (LFCNB) with periarticular and local infiltration analgesia (PALIA) in total hip arthroplasty (THA), with both modalities using dual glucocorticoids: hydrophilic dexamethasone sodium phosphate (DEX) and lipophilic methylprednisolone acetate (MPA).

METHODS: A total of 192 patients were randomized to either PALIA or aQLB+LFCNB and received 60 mL of 0.2% ropivacaine, 10 mg of DEX, and 80 mg of MPA. The mean age of the 188 included patients was 61 years, 46% were male, 96% were non-Hispanic, and 82% were White. The primary outcome was opioid consumption, measured as oral morphine milligram equivalents (oMME), on postoperative day (POD) 1. Secondary outcomes included opioid consumption on POD 2, fasting serum glucose, white blood-cell count, Brief Pain Inventory (BPI) pain severity and interference, and functional recovery measures, including Activity Measure for Post-Acute Care (AMPAC) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores, from POD 0 to 1 year.

RESULTS: Ninety-three patients in the aQLB+LFCNB group and 95 patients in the PALIA group were included in the final analysis. There was no significant difference in the primary outcome, oMME on POD 1, between the aQLB+LFCNB group (median, 29.84 [interquartile range (IQR): 17.72, 38.75]) and the PALIA group (median, 30.50 [IQR: 18.00, 42.00]) (p = 0.57). Except for fasting serum glucose on POD 1, which was lower in the aQLB+LFCNB group (median, 141.50 [IQR: 124.50, 163.50] mg/dL) than in the PALIA group (median, 153.00 [IQR 139.00, 180.00] mg/dL) (p = 0.003), no significant differences were observed in any of the other secondary outcomes.

CONCLUSIONS: Patients who received aQLB+LFCNB with dual glucocorticoids and those who received PALIA with dual glucocorticoids demonstrated no significant differences in daily opioid consumption, pain score, or functional recovery following THA.

LEVEL OF EVIDENCE: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

PMID:42127167 | DOI:10.2106/JBJS.25.01476

J Bone Joint Surg Am. 2026 May 13. doi: 10.2106/JBJS.25.00779. Online ahead of print.

ABSTRACT

BACKGROUND: Pyrocarbon hemiarthroplasty (HA) is a recent option for younger patients with end-stage glenohumeral joint (GHJ) arthritis. Early results are promising but limited by study bias. The aim of this study was to evaluate medium-term clinical and radiographic outcomes following PyroTITAN pyrocarbon HA.

METHODS: One hundred and nineteen shoulders with GHJ arthritis in 115 patients (mean age, 56.5 years; 92 shoulders were in male patients) underwent PyroTITAN pyrocarbon HA. Primary patient-reported outcome measures (PROMs) included the Western Ontario Osteoarthritis of the Shoulder Index and American Shoulder and Elbow Surgeons score. Clinicians assessed shoulder range of motion and abduction strength. PROMs and clinician evaluations were recorded preoperatively and at 6, 12, and 24 months and 5 years postoperatively. Postoperative complications were recorded, and radiographs were evaluated for glenoid erosion. Implant survival was calculated over the 5-year follow-up period. Data were analyzed on an intention-to-treat basis using linear mixed models for continuous data and Friedman analysis of variance for ordinal data. Kaplan-Meier analysis assessed revision-free survival. Significance was set at p < 0.05.

RESULTS: There was significant improvement in all PROMs and ranges of motion at 6, 12, and 24 months and 5 years postoperatively. Abduction strength was significantly improved at 24 months. Seven complications (5.9%) were recorded: ongoing pain (n = 2), stiffness (n = 2), pain and stiffness (n = 2), and implant fracture (n = 1). There were 3 revisions (2.5%) and thus a 97.5% five-year survival rate. Glenoid erosion increased slightly but not significantly over time.

CONCLUSIONS: The findings in our patient series support the PyroTITAN HA implant as a viable option for GHJ arthritis across a broad age range, including younger patients.

LEVEL OF EVIDENCE: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

PMID:42127166 | DOI:10.2106/JBJS.25.00779

Int Orthop. 2026 May 12. doi: 10.1007/s00264-026-06851-x. Online ahead of print.

NO ABSTRACT

PMID:42118305 | DOI:10.1007/s00264-026-06851-x

Int Orthop. 2026 May 12. doi: 10.1007/s00264-026-06834-y. Online ahead of print.

ABSTRACT

PURPOSE: Total hip arthroplasty (THA) presents unique technical challenges in patients who have morbid obesity, and benefits of imageless navigation in this population remain unclear. This study compared complications, thromboembolic events, and emergency department utilization between imageless navigation-assisted and manual THA in patients who have morbid obesity.

METHODS: A retrospective cohort study was performed using the PearlDiver database. Patients who have morbid obesity (BMI ≥ 40) undergoing elective primary THA between 2010 and 2021 were identified. Cases performed with robotic assistance or image-based navigation were excluded. Patients were stratified by intraoperative technique into manual and imageless navigation cohorts and matched 1:3 on age, sex, year of procedure, and comorbidities. Surgical complications, thromboembolic events, revision procedures, and emergency department visits were evaluated at multiple postoperative time points and compared using univariable regression.

RESULTS: After matching, 4,499 patients who have morbid obesity were included, comprising 3,367 manual (74.8%) and 1,132 imageless navigation (25.2%) cases. No significant differences were observed between cohorts in rates of surgical complications, including infection, dislocation, periprosthetic fracture, mechanical loosening, chronic pain, or leg length discrepancy at any evaluated time point (P > 0.05). Thromboembolic events were uncommon and did not differ between groups at 30 or 90 days. Emergency department visits and revision rates were also similar at all time points.

CONCLUSIONS: Among patients who have morbid obesity undergoing primary THA, imageless navigation was not associated with improved outcomes compared with manual techniques, suggesting postoperative risk is driven primarily by obesity-related factors. Surgeons should weigh resource utilization and patient characteristics when selecting operative technique.

PMID:42118304 | DOI:10.1007/s00264-026-06834-y

Int Orthop. 2026 May 12. doi: 10.1007/s00264-026-06836-w. Online ahead of print.

ABSTRACT

PURPOSE: To identify preoperative physical performance and muscle quality factors associated with independent ambulation one week after total hip arthroplasty (THA).

METHODS: This retrospective study included 102 patients (102 hips) who underwent primary unilateral THA via a posterior approach between June 2024 and June 2025. Patients were classified into independent (n = 54) and dependent (n = 48) ambulation groups according to their ability to walk 50 m without walking aids one week after THA. Preoperative assessments included the 30-s chair-stand test, two-step test, one-leg stance time, and Timed Up and Go test, as well as computed tomography-derived muscle attenuation values. Multivariable logistic regression was performed to identify independent predictors of independent ambulation.

RESULTS: The independent ambulation group was younger and performed better on all four physical function tests (all p < 0.05). Muscle attenuation values differed only for the rectus femoris (p = 0.003). In multivariable analysis, the two-step value was the sole independent predictor of independent ambulation (per 0.1-unit increase: OR 1.33; 95% CI 1.02-1.74; p = 0.026). The optimal cutoff value was 0.95, with a sensitivity of 75%, specificity of 76%, and area under the receiver operating characteristic curve of 0.81.

CONCLUSION: Preoperative two-step test performance independently predicted independent ambulation one week after THA. A two-step value of 0.95 may help identify patients at risk of delayed walking recovery and facilitate preoperative risk stratification.

PMID:42118303 | DOI:10.1007/s00264-026-06836-w

Injury. 2026 May 8:113350. doi: 10.1016/j.injury.2026.113350. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma is a leading cause of death and disability, both in Sweden and globally. Timely surgical intervention and level of care have been identified as important determinants of outcome, yet it is not known whether time to surgery differs between trauma centers and non-trauma centers in Sweden, or whether previously observed survival differences also apply to patients undergoing early operative management.

METHODS: This retrospective national cohort study included adult trauma patients (≥18 years) who underwent surgery within six hours of hospital arrival between 1 January 2019 and 21 March 2023. Data were obtained from Swedish national quality registries and administrative registers held by the National Board of Health and Welfare (Socialstyrelsen). The primary outcome was time from hospital arrival to initiation of surgery. Secondary outcomes were time to urgent surgery and 30-day mortality. Associations between trauma center status and outcomes were examined using regression models adjusted for demographic and injury-related factors.

RESULTS: A total of 1129 adult trauma patients who underwent surgery within six hours of hospital arrival were included, the majority presenting with moderate to severe injuries; of whom 659 (58.4%) were treated at trauma centers and 470 (41.6%) at non-trauma centers. Patients treated at trauma centers had higher injury severity and greater physiological compromise. Trauma center care was associated with shorter time to surgery; the fully adjusted mean difference was 0.68 h compared with non-trauma centers. Crude 30-day mortality was higher at trauma centers, but after full adjustment for case-mix, trauma center care was associated with lower mortality.

CONCLUSION: Among trauma patients undergoing early surgery, treatment at trauma centers was associated with shorter time to surgery and improved adjusted survival. Further research is needed to identify which patient groups may benefit most from direct transport to trauma centers.

PMID:42120216 | DOI:10.1016/j.injury.2026.113350

Injury. 2026 May 5;57(7):113340. doi: 10.1016/j.injury.2026.113340. Online ahead of print.

ABSTRACT

INTRODUCTION: The sinus tarsi approach (STA) has gained popularity as a minimally invasive alternative to the extensile lateral approach for displaced intra-articular calcaneal fractures (DIACFs), yet wound complications remain a concern. This study aimed to determine the incidence and predictors of wound complications following STA fixation.

METHODS: A retrospective multicenter cohort study was conducted across four tertiary referral hospitals, including all surgically treated DIACFs managed with STA between 2018 and 2022. Demographic, injury-related, and operative variables were extracted from medical records. The primary outcome was wound complications within eight postoperative weeks, defined as inflammation, necrosis, or persistent wound leakage >2 weeks. Secondary outcomes included reoperation and identification of risk factors.

RESULTS: 148 fractures in 143 patients were included. Wound complications occurred in 13 cases (9%), with only one requiring surgical revision; eight were treated with antibiotics. Reoperation within one year occurred in 10% of cases, with a higher, though not statistically significant, rate among patients with wound complications (21% vs. 7.5%). Significant risk factors for wound complications were psychiatric comorbidity (p = 0.012), open fractures (p = 0.032), and concomitant fractures (p = 0.021). Trends toward higher complication rates were observed with screw fixation and Sanders type III-IV fractures. No associations were found with smoking, diabetes, alcohol use, or time to surgery.

CONCLUSION: STA for DIACFs is associated with a low wound complication rate, with few cases requiring reoperation. Open fractures, psychiatric disorders, and concomitant injuries significantly increase the risk of wound complications, whereas traditional risk factors known from extensile approaches-such as smoking and diabetes-were not associated with adverse outcomes. These findings support the safety of STA and highlight the importance of recognizing patient- and injury-related risk factors in perioperative planning.

PMID:42119541 | DOI:10.1016/j.injury.2026.113340

J Bone Joint Surg Am. 2026 May 12. doi: 10.2106/JBJS.25.01235. Online ahead of print.

ABSTRACT

BACKGROUND: Povidone-iodine (PVI) irrigation is widely used to reduce surgical site infection risk; however, the appropriate concentration and timing remain uncertain. We evaluated how the PVI concentration and irrigation interval influence the early bacterial burden and tissue response in a rat model of implant-related infection.

METHODS: Female rats received a stainless steel plate contaminated with methicillin-susceptible Staphylococcus aureus . The rats were randomized to receive 0.13% PVI, 0.35% PVI, or normal saline solution irrigation every 30 or 60 minutes during a 60-minute procedure. Irrigation consisted of a 3-minute exposure followed by a saline solution rinse. Outcomes included the bacterial count after sonication, soft-tissue infection score, peri-implant bone mineral density (BMD) on microcomputed tomography (µCT), histological inflammation grading, and body weight trajectory.

RESULTS: Higher PVI concentrations and a shorter irrigation interval were associated with reduced recoverable bacterial burden. Among the 30-minute interval groups, no culturable bacteria were recovered in the 0.35% PVI group (i.e., the values were below the assay detection limit); in contrast, culturable bacteria were detectable in all of the 60-minute interval groups. PVI-treated rats demonstrated lower macroscopic infection scores and a trend toward more rapid body weight recovery compared with saline solution controls. For both irrigation intervals, µCT showed higher peri-implant BMD in the PVI-treated groups than in the saline solution controls. Histology showed less inflammation and fewer abscesses in the PVI-treated groups compared with controls, with the least inflammation observed in the group that received 0.35% PVI at 30-minute intervals.

CONCLUSIONS: In this rat model, PVI concentration and irrigation interval were associated with early differences in bacterial recovery and peri-implant tissue and bone responses. These findings are hypothesis-generating and should be interpreted as mechanistic, preclinical signals rather than as guidance for clinical practice. Further translational and clinical studies are needed to determine the relevance of these signals in humans.

CLINICAL RELEVANCE: Current practice typically involves a single 3-minute 0.35% PVI soak before wound closure. This study provides preclinical mechanistic data on how PVI concentration and irrigation timing influence early bacterial recovery in an implant-related infection model. The findings do not support changes to clinical protocols, but highlight the need for careful evaluation of cytotoxicity and safety.

PMID:42118847 | DOI:10.2106/JBJS.25.01235

J Bone Joint Surg Am. 2026 May 12. doi: 10.2106/JBJS.26.00150. Online ahead of print.

NO ABSTRACT

PMID:42118825 | DOI:10.2106/JBJS.26.00150

Int Orthop. 2026 May 11. doi: 10.1007/s00264-026-06847-7. Online ahead of print.

NO ABSTRACT

PMID:42113279 | DOI:10.1007/s00264-026-06847-7

Int Orthop. 2026 May 11. doi: 10.1007/s00264-026-06837-9. Online ahead of print.

ABSTRACT

BACKGROUND: Conventional traction therapy for LDH is widely used but has inconsistent efficacy in relieving pain and restoring motor function. Therefore, we designed and evaluated MTD that combines traction and rotation.

METHODS: A prospective randomized controlled trial with a follow-up period from January 2022 to July 2024.Patients with LDH were randomly allocated to receive either treatment with a multifunctional traction device combining traction and twisting (MTD group), or conventional lumbar traction therapy (Control group). A total of 47 patients (MTD, n = 23; Control, n = 24) completed the study and were included in the final analysis. The major outcome was assessing changes from baseline to post-treatment in Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, Japanese Orthopaedic Association (JOA) scores and magnetic resonance imaging (MRI) evaluations.

RESULTS: A total of 47 patients were included, with 23 in the MTD group and 24 in the control group. There were no specific differences between the two groups in terms of gender, age, height, weight, BMI, ODI, JOA or VAS scores at baseline date. Generalized estimating equation (GEE) analysis showed that ODI and VAS scores in the MTD group were lower compared to baseline (P < 0.05). MRI evaluation showed no notable differences between the groups in terms of Pfirrmann grading and disc protrusion severity (P > 0.05).

CONCLUSIONS: The MTD treatment is more effective in reducing low back pain and enhancing daily function than conventional treatment in patients with LDH.

TRIAL REGISTRATION: This study has been registered in the Chinese Clinical Trial Registry (ChiCTR2100053940, https://www.chictr.org.cn ).

PMID:42113278 | DOI:10.1007/s00264-026-06837-9

Injury. 2026 May 4:113338. doi: 10.1016/j.injury.2026.113338. Online ahead of print.

NO ABSTRACT

PMID:42115112 | DOI:10.1016/j.injury.2026.113338

Injury. 2026 May 2:113337. doi: 10.1016/j.injury.2026.113337. Online ahead of print.

ABSTRACT

BACKGROUND: Turret trucks are widely used to handle cargo in Japanese wholesale markets. Under Japanese law, helmet use is not mandatory for turret truck operators, which potentially increases the risk of head and neck injuries. This study aimed to describe the clinical characteristics, risk factors, and outcomes of turret truck-related head and neck injuries as the first reported analysis of this injury mechanism.

METHODS: We conducted a retrospective observational study of patients with turret truck-related head and neck injuries who were transported to St. Luke's International Hospital between January 2011 and June 2024. Demographic data, injury characteristics, and outcomes were collected. The primary outcome was the necessity for hospital admission, and the secondary outcome was functional status at discharge, measured using the modified Rankin Scale (mRS).

RESULTS: Of the 67 patients analyzed, 48 (72%) were turret drivers and 19 (28%) were non-drivers. The cohort was predominantly male (97%) with a median age of 64 years. Twenty-four patients (36%) required hospital admission, with a higher proportion among turret drivers (44%) than among non-drivers (16%). Among turret drivers, all patients with severe injuries (Injury Severity Score ≥16) and those with significant head and neck injuries (Abbreviated Injury Scale ≥3) required hospitalization. Despite injury severity, most patients achieved favorable functional outcomes, with 97% having an mRS score of 0-2 at discharge. One fatality occurred in a 70-year-old female passenger without helmet who fell from a turret truck.

CONCLUSIONS: Although most turret truck-related head and neck injuries result in favorable outcomes, a substantial proportion of patients require hospitalization. Given the predominantly older male population and the occurrence of fatal outcomes even at low speeds without helmet protection, mandatory helmet use and comprehensive safety measures should be considered to reduce injury severity in this population.

PMID:42115111 | DOI:10.1016/j.injury.2026.113337

Injury. 2026 Apr 10:113216. doi: 10.1016/j.injury.2026.113216. Online ahead of print.

NO ABSTRACT

PMID:42108111 | DOI:10.1016/j.injury.2026.113216

Injury. 2026 May 7;57(7):113348. doi: 10.1016/j.injury.2026.113348. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures represent a major public health concern in the aging population, contributing substantially to morbidity, functional decline, and mortality. Although hip fractures are widely recognized for their high early mortality risk, less is known about the comparative one-year mortality associated with first-time long bone fractures at other anatomical sites. This study evaluates one-year all-cause mortality across multiple fracture types in older adults using a large, multicenter research network.

METHODS: We performed a retrospective cohort study using the TriNetX US Collaborative Network, identifying patients ≥ 65 years with a first-time long bone fracture between 2004 and 2024. Fracture types included hip, pertrochanteric, subtrochanteric, distal femur, proximal tibia, distal tibia, proximal humerus, and distal humerus fractures. Patients with pathologic, metastatic, or multiple fractures were excluded. A non-fracture cohort of age-matched older adults served as the comparison group. The primary outcome was one-year all-cause mortality. Propensity score matching (1:1) was used to balance demographics. Relative risks (RR) with 95% confidence intervals (CIs) and Kaplan-Meier survival analyses were performed.

RESULTS: A total of 165,017 fracture patients and 4.55 million non-fracture controls were identified; 162,469 patients remained after matching per cohort. All fracture types were associated with significantly increased one-year mortality compared with matched controls (2.77%). Hip fractures demonstrated the highest risk (27.9%; RR 4.86, 95% CI 4.65-5.08), followed by pertrochanteric (23.9%; RR 4.14) and subtrochanteric fractures (15.2%; RR 2.98). Distal femur fractures carried a 9.4% mortality risk (RR 2.71). Mortality for distal humerus, distal tibia, proximal tibia, and proximal humerus fractures ranged from 5.6 to 7.1% (RR 1.63-1.97).

CONCLUSION: First-time long bone fractures in older adults are associated with significantly elevated one-year mortality, with hip and proximal femur fractures conferring the greatest risk. These findings underscore the need for early risk stratification, targeted postoperative care, fall-prevention strategies, and multidisciplinary management to reduce fracture-related mortality in the geriatric population.

PMID:42107204 | DOI:10.1016/j.injury.2026.113348

Int Orthop. 2026 May 11. doi: 10.1007/s00264-026-06838-8. Online ahead of print.

ABSTRACT

PURPOSE: Non-surgical phases of operating room (OR) time represent potentially modifiable sources of inefficiency. This study analysed OR workflow patterns across orthopaedic subspecialties and identified independent risk factors for phase-specific delays.

METHODS: This retrospective cohort study included 12,568 orthopaedic procedures at a tertiary academic centre (2012-2019). Procedures were classified into upper extremity (UE), lower extremity (LE), spine (Sp), and tumour (Tu). OR time was divided into preparation (Phase 1), surgical procedure (Phase 2), and exit (Phase 3). Phase durations were compared using one-way ANOVA with Bonferroni correction; effect size was assessed using eta squared (η2). Logistic regression was used to identify independent predictors of preparation delay (defined as Phase 1 duration > 55 min, the overall 75th percentile) and exit delay (Phase 3 duration > 37 min), with UE as the reference subspecialty.

RESULTS: Mean preparation, surgical, and exit times were 47 ± 14, 123 ± 97, and 31 ± 19 min, respectively. LE had the highest preparation phase ratio (31.5%); Sp had the longest exit time (η2 = 0.055). On logistic regression, LE independently predicted preparation delay (OR 2.42, 95%CI 2.10-2.79), and Sp predicted exit delay (OR 2.83, 95%CI 2.46-3.27).

CONCLUSION: OR workflow differs significantly across orthopaedic subspecialties. Subspecialty-specific delay patterns suggest actionable targets for perioperative efficiency improvement, and systematic monitoring of non-surgical OR phases may help foster an efficiency-conscious culture in academic orthopaedic departments.

PMID:42108330 | DOI:10.1007/s00264-026-06838-8

Injury. 2026 Apr 10;57(7):113278. doi: 10.1016/j.injury.2026.113278. Online ahead of print.

ABSTRACT

PURPOSE: Primary bipolar hip arthroplasty is commonly used to manage displaced femoral neck fractures in elderly patients, offering early mobilization and reduced surgical burden compared with total hip arthroplasty. However, long-term functional outcomes and predictors of recovery remain variable. This study aimed to prospectively evaluate the clinical and functional outcomes of primary bipolar hip arthroplasty.

METHODS: This prospective observational study included 196 patients who underwent primary bipolar hip arthroplasty between January 2016 and September 2024 in three university-affiliated teaching hospitals. Functional outcomes were assessed using the Harris Hip Score (HHS), while postoperative complications were recorded for one year. Patients were stratified by age (<60 vs. ≥60 years) to examine the impact of demographic factors on outcomes. Statistical analysis included correlation and subgroup comparisons with significance set at p < 0.05.

RESULTS: The mean age of participants was 68.7 ± 11.9 years, and the mean follow-up was 46.97 ± 25.21 months. No major complications or revision surgeries occurred; 4.0% of patients developed superficial wound infections. Overall, the mean HHS was 50.51 ± 18.59, with 79.6% of patients achieving poor scores. Younger patients (<60 years) demonstrated better functional outcomes, particularly in mobility-related domains (p = 0.06), while most older patients (≥60 years) had poor long-term functional results. A significant negative correlation was observed between age and HHS (r = -0.379, p = 0.007).

CONCLUSIONS: Bipolar hemiarthroplasty is a safe procedure with low complication and revision rates. However, long-term functional outcomes are modest, especially in elderly patients, likely influenced by age, comorbidities, preoperative status, and acetabular erosion. Individualized patient selection and long-term monitoring of hip function are recommended to optimize recovery.

PMID:42105687 | DOI:10.1016/j.injury.2026.113278

Injury. 2026 May 4;57(7):113339. doi: 10.1016/j.injury.2026.113339. Online ahead of print.

ABSTRACT

Being established as an important natural component for wound healing, acacia honey (AH) in combination with ascorbic acid (AA) was evaluated for its tissue regenerative properties to establish a synergistic effect. A thermosensitive hydrogel formulation was developed and characterized for viscosity, mucoadhesion, moisture retention, pH, and morphology, where the parameters were found to be favourable for topical application and longer retention. The porosity and swelling of the hydrogel matrix allow for prolonged and sustained release of AH and AA. The release patterns of AH and AA from the gel matrix followed the Korsmeyer-Peppas and Michaelis-Menten patterns, respectively, indicating sustained release. The optimized formulation revealed antimicrobial properties, as evidenced by the significant increase (p < 0.05) in the diameter of the zone of inhibition. Scratch wound assay using HaCaT cell line showed wound healing potential of 90.6±4.5% for the co-loaded formulation. Furthermore, the wound healing potential of the co-loaded hydrogel in the excision wound model in experimental rats could be linked to increased vascularization due to the daily application of the formulation at the wound site. The antioxidant capacity was demonstrated by decreased IC50 values of 53.75±5.9 and 72.71±6.63 µg/mL against ABTS and DPPH, respectively, which additionally supported the wound healing potential. Lastly, the synergistic role of AH and AA facilitates fibroblast proliferation, collagen production, and glycosaminoglycan deposition, which could be correlated with a significant increase in hexosamine and hexuronic acid to 153.3±9.49 and 48.91±6.84 µg/40 mg of wound tissue, respectively. Overall, the co-loaded hydrogel could be an effective alternative for the treatment of acute dermal injuries.

PMID:42105686 | DOI:10.1016/j.injury.2026.113339

Int Orthop. 2026 May 9. doi: 10.1007/s00264-026-06826-y. Online ahead of print.

NO ABSTRACT

PMID:42104988 | DOI:10.1007/s00264-026-06826-y

Injury. 2026 May 4;57(7):113336. doi: 10.1016/j.injury.2026.113336. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple rib fractures cause substantial morbidity through severe pain, impaired ventilation, and pulmonary complications. While open rib fixation is well established, thoracoscopic fixation may reduce soft-tissue trauma and enhance recovery, but comparative evidence remains unclear. This systematic review and meta-analysis aimed to compare thoracoscopic versus open fixation for multiple rib fractures in terms of effectiveness and safety outcomes.

METHODS: We conducted a systematic literature search across PubMed, Scopus and Web of Science to retrieve comparative studies comparing thoracoscopic fixation versus traditional open fixation for multiple rib fractures regarding pain, perioperative outcomes and safety outcomes. Risk of bias of included studies was assessed using the ROBINS-I tool. A meta-analysis was conducted using a random-effects model in R (version 4.5.0).

RESULTS: Nine comparative studies were identified (total participants = 751). Meta-analysis revealed that thoracoscopic fixation was associated with improved postoperative pain compared with open fixation. Pain was significantly lower with thoracoscopy on postoperative day (POD) 1 (SMD= -1.12, 95% CI -1.64 to -0.61) and POD7 (SMD= -1.90, 95% CI -3.08 to -0.73), while POD3 was not significant (SMD= -1.49, 95% CI -3.52-0.54). Thoracoscopy reduced incision length (MD= -4.19 cm) and blood loss (MD= -18.56 mL) and shortened hospital stay (MD= -2.05 days), with no difference in operative time (MD= 9.66 min). Pleural effusion was less frequent (OR 0.32, 95% CI 0.10-1.00) on thoracoscopic fixation.

CONCLUSION: There may be clinically significant benefits of thoracoscopic rib fixation over open fixation for multiple rib fractures. These benefits may include less early postoperative pain, smaller incisions, less blood loss, shorter hospital stays, and no increase in operative time. Overall complication rates were similar, but thoracoscopic fixation was associated with fewer pleural effusions. Due to significant heterogeneity and the predominance of observational studies, there is a need for more rigorous prospective trials.

PMID:42102768 | DOI:10.1016/j.injury.2026.113336